杂交技术与传统开放手术治疗主动脉弓部疾病:孰优孰劣?

Hybrid or open surgery for aortic arch diseases:Which one is better?

开放全主动脉弓部置换联合象鼻支架置入术是治疗累及主动脉弓部夹层/动脉瘤的标准术式。近年来随着腔内介入技术的发展,结合弓上血管去分支和导丝导管技术的杂交手术可缩短甚至避免体外循环或者深低温停循环,理论上能有效降低围术期各类风险,为无法接受开放手术的高危患者提供了新的治疗选择。然而,目前对于开放手术和杂交技术在治疗主动脉弓部疾病的优劣性仍存在争议,本文基于现有证据对外科治疗主动脉弓部疾病的研究进展进行简要综述。

The conventional total arch replacement(cTAR)with frozen elephant trunk implantation is commonly regarded as the gold standard for aortic pathologies involving ascending aorta and proximal aortic arch.By combining open supra-aortic vessels debranching and emerging endovascular technologies,hybrid arch repair(HAR)has been increasingly performed as a promising alternative in risky patients with comorbidities and frailties.Nevertheless,the advantages or disadvantages of hybrid arch procedures and cTAR in terms of survival and related outcomes remain controversial.This study is aimed to briefly review the role and results of HAR in the management of aortic arch pathology in comparison of contemporary cTAR.